Glans amputation at neonatal circumcision

Last year ripe-tomato.org drew readers attention to the complications mentioned in a recent WHO manual for teaching neonatal circumcision (click here).  Some were serious and probably under-reported; clumsy doctors don’t publicise their mistakes. Parents may sue, but rarely publicise their son’s injury either, and he certainly won’t. We wondered if parents were fully informed.

A recent report (J Paed Urol, Dec 2013, click here, full text here glans amputation) should give cause for thought.  Some Canadian urologists describe six cases of accidental amputation, referred over a five or ten* year period. Two were successfully reattached, albeit with deformity; it’s too soon to know whether sensation was affected. The other three required multiple reconstructive operations. Warning – it’s illustrated.

It’s a nice paper. The authors show clearly how the problem happens when the foreskin has not been fully separated before surgery, and how it can be avoided by dividing adhesions between the glans and foreskin.  Doctors performing circumcision should read it carefully. Parents will want to ensure their son gets done by an expert –  or perhaps leave him intact.

Jim Thornton

* The abstract says the injuries occurred over a five year period, but the main text says over ten. Simple error. Mistakes happen!